Email address *

    Name of your company *

    Address of your company with email address and Phone number*

    Your company website*

    Your company social media links i.e you tube twitter, facebook etc.*

    For which region/country you are proposing to distribute OrthoHeal product ? *

    Are you distributing any medical products ? or existing medical product supplier ? *
    YesNo

    Which category of following suites more to your business ? *
    Medical device sellingMedical equipment sales and serviceMedical disposableOther:

    Since when you are doing this business ? *

    How many sales people employed in your business ? *

    How much was revenue for last year ? *
    <USD 1,00,000US$ 100,000-500,000US$ 5,00,000-1,000,000US$ 1,000,000-5,000,000>US$ 5,000,000Other:

    List region in which you have strong hold for medical supply ? *

    If you have existing distributorship of medical products please name companies you are dealing with. *

    Upload files related to your business. i.e. Financial report, Company introduction video, brochures etc *

    Do you have any existing sales channel in govt. agency? *
    YesNo

    To which agency are you supplying medical products *
    Govt HospitalDefense hospitalCentral procurement of Medical insuranceGovt TendersOther:

    How big was your last order with said supply.? (in terms of USD) *

    What is your main segment of your business ? *

    Why do you think doing business with OrthoHeal is advantage for you ? *

    Howmuch investment you are willing to put for OrthoHeal Distribution ? *
    US$ 10,000-50,000US$ 50,000-1,00,000Other:

    Upload files related to your business. i.e. Financial report, Company introduction video, brochures etc